TY - JOUR
T1 - Association of residual urine output with mortality, quality of life, and inflammation in incident hemodialysis patients
T2 - The Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) study
AU - Shafi, Tariq
AU - Jaar, Bernard G.
AU - Plantinga, Laura C.
AU - Fink, Nancy E.
AU - Sadler, John H.
AU - Parekh, Rulan S.
AU - Powe, Neil R.
AU - Coresh, Josef
N1 - Funding Information:
Support: CHOICE was supported by RO1-HL-62985 ( National Heart, Lung, and Blood Institute from September 2000 to June 2006) and RO1-DK-59616 ( National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK] from September 2000 to June 2007). Dr Parekh was supported by 1UO1-DK-57304-01 and 1 R01 DK070657-01 . Dr Coresh was supported in part as an American Heart Association established investigator ( 01-4019-7N ). Dr Powe was supported in part by K24-DK-02643 ( NIDDK ). Dr Shafi was supported by 5T32-DK-007732 ( NIDDK ) and The National Kidney Foundation of Maryland Extraordinary Professional Development Award.
PY - 2010
Y1 - 2010
N2 - Background: Residual kidney function (RKF) is associated with improved survival in peritoneal dialysis patients, but its role in hemodialysis patients is less well known. Urine output may provide an estimate of RKF. The aim of our study is to determine the association of urine output with mortality, quality of life (QOL), and inflammation in incident hemodialysis patients. Study Design: Nationally representative prospective cohort study. Setting & Participants: 734 incident hemodialysis participants treated in 81 clinics; enrollment, 1995-1998; follow-up until December 2004. Predictor: Urine output, defined as producing at least 250 mL (1 cup) of urine daily, ascertained using questionnaires at baseline and year 1. Outcomes & Measurements: Primary outcomes were all-cause and cardiovascular mortality, analyzed using Cox regression adjusted for demographic, clinical, and treatment characteristics. Secondary outcomes were QOL, inflammation (C-reactive protein and interleukin 6 levels), and erythropoietin (EPO) requirements. Results: 617 of 734 (84%) participants reported urine output at baseline, and 163 of 579 (28%), at year 1. Baseline urine output was not associated with survival. Urine output at year 1, indicating preserved RKF, was independently associated with lower all-cause mortality (HR, 0.70; 95% CI, 0.52-0.93; P = 0.02) and a trend toward lower cardiovascular mortality (HR, 0.69; 95% CI, 0.45-1.05; P = 0.09). Participants with urine output at baseline reported better QOL and had lower C-reactive protein (P = 0.02) and interleukin 6 (P = 0.03) levels. Importantly, EPO dose was 12,000 U/wk lower in those with urine output at year 1 compared with those without (P = 0.001). Limitations: Urine volume was measured in only a subset of patients (42%), but agreed with self-report (P < 0.001). Conclusions: RKF in hemodialysis patients is associated with better survival and QOL, lower inflammation, and significantly less EPO use. RKF should be monitored routinely in hemodialysis patients. The development of methods to assess and preserve RKF is important and may improve dialysis care.
AB - Background: Residual kidney function (RKF) is associated with improved survival in peritoneal dialysis patients, but its role in hemodialysis patients is less well known. Urine output may provide an estimate of RKF. The aim of our study is to determine the association of urine output with mortality, quality of life (QOL), and inflammation in incident hemodialysis patients. Study Design: Nationally representative prospective cohort study. Setting & Participants: 734 incident hemodialysis participants treated in 81 clinics; enrollment, 1995-1998; follow-up until December 2004. Predictor: Urine output, defined as producing at least 250 mL (1 cup) of urine daily, ascertained using questionnaires at baseline and year 1. Outcomes & Measurements: Primary outcomes were all-cause and cardiovascular mortality, analyzed using Cox regression adjusted for demographic, clinical, and treatment characteristics. Secondary outcomes were QOL, inflammation (C-reactive protein and interleukin 6 levels), and erythropoietin (EPO) requirements. Results: 617 of 734 (84%) participants reported urine output at baseline, and 163 of 579 (28%), at year 1. Baseline urine output was not associated with survival. Urine output at year 1, indicating preserved RKF, was independently associated with lower all-cause mortality (HR, 0.70; 95% CI, 0.52-0.93; P = 0.02) and a trend toward lower cardiovascular mortality (HR, 0.69; 95% CI, 0.45-1.05; P = 0.09). Participants with urine output at baseline reported better QOL and had lower C-reactive protein (P = 0.02) and interleukin 6 (P = 0.03) levels. Importantly, EPO dose was 12,000 U/wk lower in those with urine output at year 1 compared with those without (P = 0.001). Limitations: Urine volume was measured in only a subset of patients (42%), but agreed with self-report (P < 0.001). Conclusions: RKF in hemodialysis patients is associated with better survival and QOL, lower inflammation, and significantly less EPO use. RKF should be monitored routinely in hemodialysis patients. The development of methods to assess and preserve RKF is important and may improve dialysis care.
KW - End-stage renal disease
KW - hemodialysis
KW - inflammation
KW - mortality
KW - quality of life
KW - residual kidney function
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U2 - 10.1053/j.ajkd.2010.03.020
DO - 10.1053/j.ajkd.2010.03.020
M3 - Article
C2 - 20605303
AN - SCOPUS:77955901447
SN - 0272-6386
VL - 56
SP - 348
EP - 358
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -